Active NPI
Vicky Walesca De Micco
- Physical Therapist
- Columbia, SC
National Provider Identifier
1316213408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7989
- Practice address
- 731 Polo Rd
Columbia, SC 29223-4462 - Phone
- (803) 238-5635
- NPI assigned
- Mar 22, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA01343000 | NJ | |
| Physical Therapist | 225100000X | 7989 | SC | Primary |
Addresses
Primary practice location
731 Polo Rd
Columbia, SC 29223-4462
Mailing address
731 Polo Rd
Columbia, SC 29223-4462
Phone (803) 238-5635
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA01343000 | NJ | MD | Physical Therapist |
| 7989 | SC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1316213408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 POLO RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292234462",
"telephone_number": "803-238-5635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 POLO RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292234462",
"telephone_number": "803-238-5635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE MICCO",
"first_name": "VICKY",
"middle_name": "WALESCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-22",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01343000",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "7989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.